Charlotte Maxeke Johannesburg Academic Research Articles

Antimicrobial resistance and antimicrobial stewardship in South Africa: a survey of healthcare workers in academic and nonacademic hospitals.

Antimicrobial stewardship programmes (ASPs) facilitate appropriate antimicrobial use and require contextualization for optimal functioning. We aimed to investigate perceptions of and antimicrobial resistance (AMR) and ASPs among healthcare workers in academic and nonacademic hospitals. Cross-sectional survey. Three academic (Charlotte Maxeke Johannesburg Academic, Inkosi Albert Luthuli, Tygerberg) and three nonacademic hospitals (Leratong, Prince Mshiyeni Memorial, and Paarl) in South Africa from January to June 2022. Doctors, nurses, and pharmacists. Voluntary questionnaire using Google Forms, encompassing AMR, ASPs, and selected discipline-specific components. Participants comprised 79 doctors (50 academic), 178 nurses (169 academic), and 21 pharmacists (18 academic) and were female predominant. AMR was a problem in academic hospitals (74.7% vs 51.2%, p 0.004); 73.5% overall reported inappropriate antimicrobial use as a major contributor. Adequate education on antimicrobials occurred in only 36.4% overall. Microbiological testing guided therapy more often in nonacademic settings (80.0% vs 50.2%, p <0.001). In both settings, antimicrobial availability drove selection in 48.2%. Overall, ASPs improved patient care (89.8%) and reduced antimicrobial use (86.9%), although felt to override prescriber autonomy in academic settings (29.4% vs 7.5%, p 0.007), mainly among nurses. Only 50.2% reported successful local ASPs. A minority of pharmacists (20.0%) reported sufficient hospital support for ASPs. Education, involvement of infection control staff, and inclusion of nurses in ASPs were most impactful on AMR. Selected healthcare worker perspectives differ by category and setting and can be targeted to improve ASPs. Further studies should target a higher number of clinical staff in both settings.

Sarcoidosis in Johannesburg, South Africa: A retrospective study.

Sarcoidosis is a multisystem granulomatous condition of uncertain aetiology that most frequently affects the lungs. Because of clinical and radiological similarities with tuberculosis (TB), particularly in high-prevalence regions, sarcoidosis is frequently misdiagnosed as TB. To review the clinical features of sarcoidosis patients in a South African (SA) population, adding clinical information to the relatively few studies that have been conducted in SA patients with sarcoidosis. This was a retrospective study of 102 sarcoidosis patients conducted between 2002 and 2006 at the Charlotte Maxeke Johannesburg Academic Hospital. Of 102 sarcoidosis patients, there were 69 (67.6%) females and 33 (32.4%) males. The majority (85.3%) were non-smokers. The mean age of the group was 44.6 years. One-third of patients had chronic comorbid diseases. Almost 17% had been treated initially for TB, prior to being diagnosed as having sarcoidosis. Two patients developed active TB while receiving corticosteroid treatment for sarcoidosis. The salient clinical manifestations were dry cough (the most common presenting symptom in 82.4%), dyspnoea in 53.9%, cutaneous lesions other than erythema nodosum in 33.3%, and on lung examination crackles were noted in 37.3% of patients. Raised angiotensin-converting enzyme (ACE) levels were found in 56.8% of patients. The majority (48%) of patients had stage II chest radiographic changes. Cutaneous (28.4%), mediastinal lymph node (25.5%) and transbronchial lung (25.5%) biopsies were the most frequent sites confirming granulomatous inflammation. Overall, 21.2% of patients had obstructive airway disease. Systemic corticosteroids were indicated in 87.3% of patients and the relapse rate was 60.7%. Sarcoidosis is often initially misdiagnosed as TB in SA. The most common biopsy sites for histological confirmation were the skin and mediastinal lymph nodes, and transbronchial lung biopsies were also frequently taken. Stage II chest radiographic changes were most common. Overall, systemic corticosteroids were administered in 87.3% of cases and the relapse rate was 60.7%.

Comparison of measured LDL cholesterol with calculated LDL-cholesterol using the Friedewald and Martin-Hopkins formulae in diabetic adults at Charlotte Maxeke Johannesburg Academic Hospital/NHLS Laboratory.

The National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) and the European Society of Cardiology recommend using low-density lipoprotein cholesterol (LDL-C) as a treatment target for cholesterol lowering therapy. The Friedewald formula underestimates LDL-C in non-fasted and hypertriglyceridemia patients. This study aimed to compare measured LDL-C to calculated LDL-C in diabetic patients using the Friedewald and Martin-Hopkins formulae. The data of 1 247 adult diabetes patients were retrospectively evaluated, and included triglycerides (TG), LDL-C, total cholesterol, and high-density lipoprotein cholesterol that were measured on the Roche Cobas® c702. Passing-Bablok regression analysis was used to determine the degree of agreement between measured LDL-C and calculated LDL-C using both formulae. The Bland-Altman plots were used to assess the bias at medical decision limits based on the 2021 European Society of Cardiology (ESC) guidelines on cardiovascular disease prevention in clinical practice. Both formulae showed a good linear relationship against measured LDL-C. However, the Martin-Hopkins formula outperformed the Friedewald formula at LDL-C treatment target <1.4mmol/L. The Friedewald formula and the Martin-Hopkins formula had 14.9% and 10.9% mean positive bias, respectively. At TG-C ≥1.7 mmol/L, the Martin-Hopkins formula had a lower mean positive bias of 4.2% (95% CI 3.0-5.5) compared to the Friedewald formula, which had a mean positive bias of 21.8% (95% CI 19.9-23), which was higher than the NCEP ATP III recommended total allowable limit of 12%. The Martin-Hopkins formula performed better than the Friedewald formula at LDL-C of 1.4 mmol/L and showed the least positive bias in patients with hypertriglyceridemia.

Fatal non-accidental injury in South Africa: A Gauteng hospital's perspective on the incidence and fracture types in post-mortem skeletal surveys.

BackgroundIn its severest form, non-accidental injury (NAI) in children is fatal. South Africa has been reported to have double the global average of child homicides. Autopsy is the main investigation in fatal NAI with post-mortem skeletal surveys (PMSS) playing an adjunctive role. Whilst fracture patterns associated with NAI in living patients have been established, this has not been investigated in PMSS in South Africa.ObjectivesTo determine the incidence and characteristics of fractures in suspected fatal NAI cases. To calculate the incidence of fractures according to high-, moderate- and low-specificity fracture locations for NAI.MethodsA retrospective review of all PMSS performed between 01 January 2012 and 03 December 2018 was conducted at the Charlotte Maxeke Johannesburg Academic Hospital.ResultsOf the 73 PMSS, 33 (45.2%) demonstrated fractures. No statistical significance in sex was found: 38 (52.1%) were male and 35 (47.9%) were female (p > 0.05). The mean age of those who sustained fractures was 28 months (standard deviation [s.d.]: 21 months). A total of 115 fractures were sustained, of that the top five bones fractured were the ribs 37 (32.2%), parietal bone 13 (11.3%), ulna 13 (11.3%), femur 13 (11.3%), and radius 11 (9.6%). High-specificity fracture locations accounted for 40/133 (30.1%).ConclusionThe fracture types in PMSS were similar to those in live skeletal surveys. Our study’s fracture rate was higher in comparison to international studies. The PMSS is a valuable adjunct to autopsy in detecting occult fractures of the limbs. We recommend that PMSS be performed in suspected fatal NAI cases at least in children up to 24 months of age.

Survival of south african women with breast cancer receiving anti-retroviral therapy for HIV

PurposeBreast cancer outcomes in sub-Saharan Africa is reported to be poor, with an estimated five-year survival of 50% when compared to almost 90% in high-income countries. Although several studies have looked at the effect of HIV in breast cancer survival, the effect of ARTs has not been well elucidated. MethodsAll females newly diagnosed with invasive breast cancer from May 2015–September 2017 at Charlotte Maxeke Johannesburg Academic and Chris Hani Baragwanath Academic Hospital were enrolled. We analysed overall survival and disease-free survival, comparing HIV positive and negative patients. Kaplan-Meier survival curves were generated with p-values calculated using a log-rank test of equality while hazard ratios and their 95% confidence intervals (CIs) were estimated using Cox regression models. ResultsOf 1019 patients enrolled, 22% were HIV positive. The overall survival (95% CI) was 53.5% (50.1–56.7%) with a disease-free survival of 55.8% (52.1–59.3) after 4 years of follow up. HIV infection was associated with worse overall survival (HR (95% CI): 1.50 (1.22–1.85), p < 0.001) and disease-free survival (OR (95% CI):2.63 (1.71–4.03), p < 0.001), especially among those not on ART at the time of breast cancer diagnosis. Advanced stage of the disease and hormone-receptor negative breast cancer subtypes were also associated with poor survival. ConclusionHIV infection was associated with worse overall and disease-free survival. HIV patients on ARTs had favourable overall and disease-free survival and with ARTs now being made accessible to all the outcome of women with HIV and breast cancer is expected to improve.

Exploring the knowledge, attitudes and practices (KAP) of health care professionals on viral hepatitis notification in Gauteng, South Africa, 2015

BackgroundData on viral hepatitis in South Africa is scarce. Although viral hepatitis A, B and C are notifiable conditions in South Africa, discrepancies have been noted in the number of viral hepatitis cases notified by the National Department of Health (NDOH) compared with laboratory confirmed cases from the National Institute for Communicable Diseases (NICD). The aim of the study was to assess the knowledge, attitudes and practices of health care professionals on the notification of viral hepatitis A, B and C.MethodsA descriptive, cross-sectional study on 385 health care professionals was conducted at Charlotte Maxeke Johannesburg Academic and Tshwane District hospitals in Gauteng province, South Africa, between March and May 2015. A pre-tested, structured questionnaire with 21 (6 demographic and 15 knowledge, attitudes, and practice (KAP)) questions was used to collect information from invited participants. A score was assigned to each KAP question and a mean (SD) score was calculated for each section. Data were analyzed using descriptive statistics in STATA version 13.ResultsOf the total 385 respondents, 65% (n = 250) were nurses and 35% (n = 135) were doctors. The overall mean knowledge score for health care professionals was 2.0 ± 1.6 (mean ± SD) out of a score of 6 regarding viral hepatitis notification. Overall mean scores of practice and attitude towards notification were higher at 2.9 ± 0.4 and 3.3 ± 0.7, out of a score of 4 and 5, respectively. Lack of training, poor knowledge, a complex process and excessive workload were some of the reasons for poor notification of viral hepatitis.ConclusionsOverall, knowledge on notification of viral hepatitis was poor among health care professionals. Adequate training on viral hepatitis, notification process, roles and responsibilities of health care professionals to notify and the implication of viral hepatitis notifications is recommended to improve reporting rate of notifiable diseases and referrals to increase linkage to care.

Usage of antibiotics in the intensive care units of an academic tertiary-level hospital

Background: The post-antibiotic era is approaching fast as multidrug-resistant bacteria emerge and the antibiotic pipeline slows to a trickle. Antibiotic stewardship requires that antibiotics be used appropriately and as such this study reviewed the utilisation of antibiotics in five adult intensive care units (ICUs) at Charlotte Maxeke Johannesburg Academic Hospital.Methods: A retrospective, cross-sectional record review of admissions to the Coronary, Cardiothoracic, Multidisciplinary, Neurology and Trauma ICUs was conducted over one month. Information from the ICU chart was captured on a modified version of the South African Antibiotic Stewardship Programme, Antibiotic Prescription Chart.Results: A total of 204 files were reviewed with 55.2% of patients receiving antibiotics during admission. The three most frequently prescribed were amoxicillin clavulanate (n = 46), piperacillin/tazobactam (n = 32) and cefazolin (n = 28), while colistin was used on one occasion. The majority of antibiotics (84.9%) were given for five days or less. Of concern however, of 35 instances where concurrent administration of antibiotics occurred, 8 had a similar spectrum and on 7 occasions the duration of antibiotic treatment was longer than 7 days. Cultures were ordered on 228 occasions. In patients receiving antibiotics 61.6% had cultures ordered; however, only 56.3% of these were taken before or on the day that antibiotics were started.Conclusion: This study showed that generally the duration of antibiotic treatment was short, concurrent use of antibiotics was minimal and the use of a restricted formulary limited the use of specific antibiotics such as colistin. However, implementation of stewardship principles and ordering of appropriate cultures would assist in further improving appropriate use of antibiotics in the ICU setting.

Paediatric splenectomy: The Johannesburg experience

Background. Splenectomy is an uncommon procedure in children, and data on children who underwent splenectomy in South Africa are sparse. Objective. To describe the profile, operative management and outcomes of children undergoing splenectomy. Methods. The records for all children aged 0 to 16 years who underwent splenectomy at Charlotte Maxeke Johannesburg Academic (CMJAH) and Chris Hani Baragwanath Academic (CHBAH) hospitals between 2000 and 2015 were reviewed. Student’s t -tests and χ 2 tests were used to analyse the data. Results. The mean age at surgery was 9.9 years (range 3-16). Most splenectomies (91%; n =30/33) were performed for haematological disorders and were open (67%; n =22/33). The mean post-operative length of stay (LOS) was shorter in the laparoscopic (4.5 days) than the open (7.1 days) groups ( p <0.05). Surgical complications were more common in the laparoscopic (36%, 4/11) than open (9%; n =2/22) group, and in children older than the mean age at time of surgery. No cases of overwhelming post splenectomy infection (OPSI) were noted. At study completion, 61% ( n =20/33) of patients were alive, 9% ( n =3/33) had demised, and 30% ( n =10/33) were lost to follow-up. Conclusion. Local indications for paediatric splenectomy mirror those found in international literature. Mean and median postoperative lengths of stay (LOS) were shorter in the laparoscopic than open group, but relatively longer for both groups than reported internationally. Laparoscopy is not currently the preferred technique for splenectomy in our setting. All mortalities were due to progression of underlying disease and no cases of OPSI were recorded. The high loss-to-follow-up rate in this study is a significant barrier to accurate data collection, analysis and reporting.

The implementation of guidelines in a South African population with type 2 diabetes

Objective: The aim of this study was to identify the treatment gaps that pertain to risk factors in South African patients with type 2 diabetes mellitus, using national treatment guidelines.Design: Cross-sectional study.Setting and subjects: The study consisted of 666 patients with type 2 diabetes mellitus, attending a diabetes clinic at the Charlotte Maxeke Johannesburg Academic Hospital.Outcome measures: Using a public sector database, retrospective data were obtained on the treatment of type 2 diabetes mellitus participants. Patients were randomly selected on the basis of established type 2 diabetes mellitus diagnosis, and if they were receiving oral hypoglycaemic and/or insulin therapy. Age, gender, race, blood pressure, haemoglobin A1c (HbA1c) and fasting lipids were captured and measured. The history of patients' previous coronary artery disease, strokes, nephropathy, neuropathy and retinopathy was recorded.Results: The mean age of the patients was 63 years [standard deviation (SD) 11.9], 55% of whom were females. The HbA1c was 8.8% (SD 2.5). 26.2% of patients attained HbA1c levels of < 7%. Of the total patients, 45.8% met a < 130/80 mmHg blood pressure target, and 53.8% a low-density lipoprotein (LDL) cholesterol of < 2.5 mmol/l. Only 7.5% obtained the combined target for HbA1c, blood pressure and LDL cholesterol.Conclusion: Traditionally, type 2 diabetes mellitus treatment has centred on correcting blood glucose levels. Yet, as many as 80% of people with type 2 diabetes mellitus die from some form of cardiovascular disease (CVD). Many trials have demonstrated the benefits of targeting CVD risk factors (HbA1c, blood pressure and lipids) in patients with type 2 diabetes mellitus. Despite the wealth of evidence, our data suggest that significant undertreatment of risk factors in patients with type 2 diabetes mellitus remains.

The implementation of guidelines in a South African population with type 2 diabetes

Objective: The aim of this study was to identify the treatment gaps that pertain to risk factors in South African patients with type 2 diabetes mellitus, using national treatment guidelines.Design: Cross-sectional study.Setting and subjects: The study consisted of 666 patients with type 2 diabetes mellitus, attending a diabetes clinic at the Charlotte Maxeke Johannesburg Academic Hospital.Outcome measures: Using a public sector database, retrospective data were obtained on the treatment of type 2 diabetes mellitus participants. Patients were randomly selected on the basis of established type 2 diabetes mellitus diagnosis, and if they were receiving oral hypoglycaemic and/or insulin therapy. Age, gender, race, blood pressure, haemoglobin A1c (HbA1c) and fasting lipids were captured and measured. The history of patients' previous coronary artery disease, strokes, nephropathy, neuropathy and retinopathy was recorded.Results: The mean age of the patients was 63 years [standard deviation (SD) 11.9], 55% of whom were females. The HbA1c was 8.8% (SD 2.5). 26.2% of patients attained HbA1c levels of < 7%. Of the total patients, 45.8% met a < 130/80 mmHg blood pressure target, and 53.8% a low-density lipoprotein (LDL) cholesterol of < 2.5 mmol/l. Only 7.5% obtained the combined target for HbA1c, blood pressure and LDL cholesterol.Conclusion: Traditionally, type 2 diabetes mellitus treatment has centred on correcting blood glucose levels. Yet, as many as 80% of people with type 2 diabetes mellitus die from some form of cardiovascular disease (CVD). Many trials have demonstrated the benefits of targeting CVD risk factors (HbA1c, blood pressure and lipids) in patients with type 2 diabetes mellitus. Despite the wealth of evidence, our data suggest that significant undertreatment of risk factors in patients with type 2 diabetes mellitus remains.

Lipid accumulation and alkaline phosphatase activity in human preadipocytes isolated from different body fat depots

AbstractBackground: Alkaline phosphatase (ALP) controls intracellular lipid accumulation in human preadipocytes, but it is not known whether ALP is expressed in all body fat depots, or whether it has a similar role at all sites.Design: Cross-sectional.Setting and subjects: Subjects undergoing breast reduction and abdominal fat biopsies operations at Charlotte Maxeke Johannesburg Academic Hospital.Outcome measures: This study compared intracellular lipid accumulation and ALP activity in the presence and absence of ALP inhibitors in preadipocytes that were obtained from different adipose depots. Abdominal and mammary gland preadipocytes were isolated from women and induced to differentiate in culture. ALP activity and intracellular lipid levels were measured at baseline and after 12 days of differentiation in the presence and absence of the ALP inhibitors, histidine and levamisole.Results: ALP activity was detected in nondifferentiated abdominal (134 ± 7.5 mU/mg protein) and mammary gland (136 ± 9.6 mU/mg p...

Gauteng’s disaster management clinicians outline World Cup shortfalls

A lack of standardised disaster management protocols, poor inter-communication between health care authorities and emergency rescue services and shaky environmental health and port health controls threaten Gauteng’s risk preparedness for the 2010 World Cup. This emerged from interviews with the top clinicians responsible for disaster management at Charlotte Maxeke Johannesburg Academic, Chris Hani Baragwanath and Helen Joseph hospitals last month. While making herculean efforts to ensure they are as prepared as possible by June, the hands-on managers admitted that it would take ‘some stepping up’ to handle a ‘surge’ beyond their current near-peak capacity operations on any difficult weekend. Depending on which public hospital Izindaba spoke to, the challenges came down to shortages of clinical and support staff, equipment, and ICU and trauma nursing skills, and budget shortfalls.